Effect of the China NCDP policy on anticoagulation selection and hemorrhage events in patients with AF in Suining

Background: :China began to launch the National Centralized Drug Procurement(NCDP) policy in March 2019 to improve public hospitals’ drug use model.After non-vitamin K antagonist oral anticoagulants(NOACs) entered the purchase list, medical institutions in Suining County of Xuzhou began widely using NOACs on March 1, 2020. Objective: : To study the effect of the NCDP policy on anticoagulation, medication and hemorrhage events in patients with non-valvular atrial fibrillation(AF) in Suining. Methods: : In this study, we used the hospitalization data of the Department of Cardiology of Suining County People’s Hospital from January 1, 2017 to June 30, 2022. General data collected included sex, age, type of health insurance, admission year, hospitalization costs, anticoagulants, use of anticoagulants, etc. Stroke risk stratification of patients with AF using CHA2DS2-VASc score classified patients with CHA2DS2-VASC score ≥ 2 as high risk and those with CHA2DS2-VASC score < 2 as medium and low risk. Results: : 3,986 patients with non-valvular atrial fibrillation(NVAF) were analyzed in the study. 1. The cost after procurement was significantly higher for hospitalized patients than it was before the implementation of the policy(8900.57±9023.02CNY vs 9829.99±10886.87CNY,P<0.001). 2. The proportion of oral anticoagulants increased significantly after the NCDP policy(40.02%vs61.33%,P<0.001), especially the use of NOACs among them(15.41%vs90.99%,P<0.001). 3. The proportion of patients with hemorrhage events decreased significantly after the implementation of the NCDP policy(1.88%vs 0.66%,P=0.01). 4. In the 219 re-hospitalized patients, the anticoagulant rate increased significantly after the NCDP policy(36.07%vs59.82%, P<0.001) ,the use of NOACs increased significantly among them（11.39%vs80.92%, P<0.001). 5. Whether the patient changes the type of anticoagulant or not has nothing to do with age, type of health insurance, hospitalization cost and antiplatelet. The NCDP policy[OR=511.703,95% CI(103.879,2520.618), P<0.001] is the only factor that affects the change of anticoagulant type. Conclusion: The NCDP policy improves the anticoagulant rate and drug compliance in patients with AF, and significantly reduces hemorrhage events.The NCDP policy is the only factor that affects the change of anticoagulant type.